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Weaning mechanical ventilation

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https://www.readbyqxmd.com/read/28726362/early-hypertension-after-vasopressor-weaning-during-septic-shock-associated-factors-and-prognostic-significance
#1
Rostane Gaci, Jérémie Lemarie, Marie Conrad, Aurélie Cravoisy, Pierre E Bollaert, Sébastien Gibot
BACKGROUND: During septic shock, early development of hypertension after vasopressors weaning seems paradoxical. The aim of this study was to authenticate this empirical observation, identify associated factors and document its prognostic significance. METHODS: We conducted a descriptive, retrospective study in a medical ICU of a teaching hospital among adult patients with septic shock. RESULTS: From 01.01.2013 to 31.12.2014, 262 consecutive patients over 18 years of age were admitted because of septic shock; 195 of them were successfully weaned from vasopressors...
July 20, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28720673/challenges-with-implementation-of-a-respiratory-therapist-driven-protocol-of-spontaneous-breathing-trials-in-the-pediatric-icu
#2
Conrad Krawiec, Dale Carl, Christy Stetter, Lan Kong, Gary D Ceneviva, Neal J Thomas
BACKGROUND: Timely ventilator liberation is crucial in the pediatric ICU. In many pediatric ICUs, the decision to initiate weaning is driven by the physician, which may lead to delays in ventilator liberation. The objectives of this quality improvement project were to develop and implement a respiratory therapist (RT)-led protocol for screening for spontaneous breathing trial (SBT) readiness, to test protocol feasibility, and to evaluate its impact on SBT timing. METHODS: A retrospective chart review was performed on all intubated patients in the pediatric ICU for 18 months prior to protocol institution...
July 18, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28713509/mechanical-ventilation-practice-in-egyptian-pediatric-intensive-care-units
#3
Bassant Salah Meligy, Sally Kamal, Seham Awad El Sherbini
INTRODUCTION: Mechanical ventilation is one of the indispensable tools in pediatric intensive care units. Few studies addressed the epidemiology of pediatric patients on mechanical ventilation and the frequently used modes of ventilation. This is the first study to describe the practice of mechanical ventilation (MV) in Egyptian pediatric intensive care units (PICUs). METHODS: This prospective observational study was conducted from January 2014 to December 2014 in two pediatric intensive care units at Cairo University Pediatric Hospital...
May 2017: Electronic Physician
https://www.readbyqxmd.com/read/28705653/solving-the-extubation-equation-successfully-weaning-infants-born-extremely-preterm-from-mechanical-ventilation
#4
EDITORIAL
Brett J Manley, Peter G Davis
No abstract text is available yet for this article.
July 10, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28698263/ventilator-induced-diaphragmatic-dysfunction-diagnosis-and-role-of-pharmacological-agents
#5
REVIEW
Won-Young Kim, Chae-Man Lim
The use of controlled mechanical ventilation results in a major reduction of diaphragmatic contractile force together with atrophy of diaphragm muscle fibers, which is a condition known as ventilator-induced diaphragmatic dysfunction. Ventilator-induced diaphragmatic dysfunction is one of the major contributors to weaning difficulties and even increased mortality. This review summarizes the current data on the pathogenesis and diagnosis of ventilator-induced diaphragmatic dysfunction, and it outlines the use of ultrasonography for diaphragm evaluation...
July 11, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28697778/electrical-impedance-tomography-for-predicting-failure-of-spontaneous-breathing-trials-in-patients-with-prolonged-weaning
#6
Johannes Bickenbach, Michael Czaplik, Mareike Polier, Gernot Marx, Nikolaus Marx, Michael Dreher
BACKGROUND: Spontaneous breathing trials (SBTs) on a T-piece can be difficult in patients with prolonged weaning because of remaining de-recruitment phenomena and/or insufficient ventilation. There is no clinically established method existent other than experience for estimating whether an SBT is most probably beneficial. Electrical impedance tomography (EIT) is a clinical useful online monitoring technique during mechanical ventilation, particularly because it enables analysis of effects of regional ventilation distribution...
July 12, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28693057/-the-value-of-the-excursion-of-diaphragm-tested-by-ultrosonography-to-predict-weaning-from-mechanical-ventilation-in-icu-patients
#7
L X Liu, D Su, Z J Hu
Objective: To evaluate the excursion of the diaphragm and analyze the value in predicting weaning from mechanical ventilation in intensive care unit patients. Methods: The patients with mechanical ventilation (>48 hours) in ICU at Hebei Forth Medical University Hospital from June 2014 to December were classified into a success group or a failure group according to the weaning outcome. T-piece spontaneous breathing (SBT), airway occlusion pressure at 0.1 sec (P(0.1)) and maximal inspiratory pressure (MIP), rapid shallow breathing index (RSBI) and P(0...
July 1, 2017: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
https://www.readbyqxmd.com/read/28682859/multidisciplinary-interventions-and-continuous-quality-improvement-to-reduce-unplanned-extubation-in-adult-intensive-care-units-a-15-year-experience
#8
Chien-Ming Chao, Chih-Cheng Lai, Khee-Siang Chan, Kuo-Chen Cheng, Chung-Han Ho, Chin-Ming Chen, Willy Chou
We conduct a retrospective study of patients with unplanned extubation (UE) in adult intensive care units (ICU) at a medical center. In 2001, a multidisciplinary team of intensivists, senior residents, nurses, and respiratory therapists was established at Chi Mei Medical Center. The improvement interventions, implemented between 2001 and 2015, were organized around 8 key areas: standardizing procedures, improving communication skills, revising sedation and weaning protocols, changing strategies for restraints, establishing a task force for identifying and managing high-risk patients, using new quality-improvement models as breakthrough series and team resource management, using the strategy of accountability without assigning blame, and changing a new method to secure endotracheal tube...
July 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28679200/closed-loop-ventilation-mode-in-intensive-care-unit-a-randomized-controlled-clinical-trial-comparing-the-numbers-of-manual-ventilator-setting-changes
#9
Jean-Michel Arnal, Aude Garnero, Dominik Novotni, Gaëlle Corno, Stéphane Y Donati, Didier Demory, Gabrielle Quintana, Laurent Ducros, Thomas Laubscher, Jacques Durand-Gasselin
BACKGROUND: There is an equipoise regarding closed-loop ventilation modes and the ability to reduce workload for providers. On one hand some settings are managed by the ventilator but on another hand the automatic mode introduces new settings for the user. METHODS: This randomized controlled trial compared the number of manual ventilator setting changes between a full closed loop ventilation and oxygenation mode (INTELLiVENT-ASV®) and conventional ventilation modes (volume assist control and pressure support) in intensive care unit (ICU) patients...
July 5, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28675113/low-levels-of-physical-activity-during-critical-illness-and-weaning-the-evidence-reality-gap
#10
Bronwen A Connolly, Jessica L Mortimore, Abdel Douiri, Joleen W Rose, Nicholas Hart, Susan C Berney
BACKGROUND: Physical rehabilitation can benefit critically ill patients during intensive care unit (ICU) admission, but routine clinical practice remains inconsistent nor examined in prolonged mechanical ventilation patients transferred to a specialist ventilator weaning unit (VWU). Behavioral mapping is a sampling approach that allows detailed reporting of physical activity profiles. The objective of this study was to characterize the physical activity profile of critically ill patients in a UK ICU and VWU...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28650414/combined-thoracic-ultrasound-assessment-during-a-successful-weaning-trial-predicts-postextubation-distress
#11
Stein Silva, Dalinda Ait Aissa, Pierre Cocquet, Lucille Hoarau, Jean Ruiz, Fabrice Ferre, David Rousset, Michel Mora, Arnaud Mari, Olivier Fourcade, Béatrice Riu, Samir Jaber, Bénoît Bataille
BACKGROUND: Recent studies suggest that isolated sonographic assessment of the respiratory, cardiac, or neuromuscular functions in mechanically ventilated patients may assist in identifying patients at risk of postextubation distress. The aim of the present study was to prospectively investigate the value of an integrated thoracic ultrasound evaluation, encompassing bedside respiratory, cardiac, and diaphragm sonographic data in predicting postextubation distress. METHODS: Longitudinal ultrasound data from 136 patients who were extubated after passing a trial of pressure support ventilation were measured immediately after the start and at the end of this trial...
June 23, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28649575/ecmo-in-major-burn-patients-feasibility-and-considerations-when-multiple-modes-of-mechanical-ventilation-fail
#12
Jason D Kennedy, Wesley Thayer, Reuben Beuno, Kelly Kohorst, Avinash B Kumar
BACKGROUND: We report two cases of acute respiratory distress syndrome in burn patients who were successfully managed with good outcomes with extra corporeal membrane oxygenation (ECMO) after failing multiple conventional modes of ventilation, and review the relevant literature. CASE PRESENTATION: The two patients were a 39-year-old male and 53-year-old male with modified Baux Scores of 79 and 78, respectively, with no known inhalation injury. After the initial modified Parkland-based fluid resuscitation and partial escharotomy, both patients developed worsening hypoxemia and acute respiratory distress syndrome...
2017: Burns and trauma
https://www.readbyqxmd.com/read/28645964/the-predictive-value-of-serial-changes-in-diaphragm-function-during-the-spontaneous-breathing-trial-for-weaning-outcome-a-study-protocol
#13
Pengmin Zhou, Zhongheng Zhang, Yucai Hong, Huabo Cai, Hui Zhao, Peifeng Xu, Yiming Zhao, Shengping Lin, Xuchang Qin, JiaWei Guo, Yun Pan, Junru Dai
INTRODUCTION: There is a variety of tools being used in clinical practice for the prediction of weaning success from mechanical ventilation. However, their diagnostic performances are less than satisfactory. The purpose of this study is to investigate the value of serial changes in diaphragm function measured by ultrasound during the spontaneous breathing trial (SBT) as a weaning predictor. METHODS AND ANALYSIS: This is a prospective observational study conducted in a 10-bed medical emergency intensive care unit (EICU) in a university-affiliated hospital...
June 23, 2017: BMJ Open
https://www.readbyqxmd.com/read/28631342/efficacy-of-a-high-observation-protocol-in-major-head-and-neck-cancer-surgery-a-prospective-study
#14
Brittany Barber, Jeffrey Harris, Cameron Shillington, Shannon Rychlik, Joseph Dort, Michael Meier, Angela Estey, Adam Elwi, Patty Wickson, Michael Buss, David Zygun, Kal Ansari, Vincent Biron, Daniel O'Connell, Hadi Seikaly
BACKGROUND: The purpose of this study was to optimize an existing clinical care pathway (CCP) for head and neck cancer with a high-observation protocol (HOP) and to determine the effect on length of intensive care unit (ICU) admission and length of stay in hospital (LOS). METHODS: The HOP mandated initiation of spontaneous breathing trials before the conclusion of the surgery, weaning of sedation, and limiting mechanical ventilation. All patients with head and neck cancer undergoing primary surgery on the HOP were compared to a historical cohort regarding length of ICU admission, ICU readmissions, and LOS...
August 2017: Head & Neck
https://www.readbyqxmd.com/read/28630772/severe-rhabdomyolysis-due-to-presumed-drug-interactions-between-atorvastatin-with-amlodipine-and-ticagrelor
#15
Iouri Banakh, Kavi Haji, Ross Kung, Sachin Gupta, Ravindranath Tiruvoipati
Atorvastatin and ticagrelor combination is a widely accepted therapy for secondary prevention of ischaemic heart disease. However, rhabdomyolysis is a well-known rare side effect of statins which should be considered when treatments are combined with cytochrome P450 3A4 enzyme inhibitors. We report a case of atorvastatin and ticagrelor associated severe rhabdomyolysis that progressed to multiorgan failure requiring renal replacement therapy, inotropes, intubation, and mechanical ventilation. Despite withdrawal of the precipitating cause and the supportive measures including renal replacement therapy, creatinine kinase increased due to ongoing rhabdomyolysis rapidly progressing to upper and lower limbs weakness...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28627353/-ultrasonographic-evaluation-of-diaphragm-structure-and-function
#16
Feifei Wang, Xiaoping Zhu, Shaolin Ma
Diaphragm is the principal respiratory muscle. Diaphragm dysfunction resulting from mechanical ventilation, chronic cardiopulmonary disease, medicine, cardio-thoracic surgery, septic shock and chronic malnutrition predisposes to weaning failure from mechanical ventilation and prolongs intensive care unit (ICU) stay. Traditionally, the method of assessment of diaphragm structure and function was invasive, lacking specific, and was difficult to be used bedside. A number of recent studies have been suggested that ultrasonographic evaluation has been proposed as an accurate, safe and noninvasive method of quantification of diaphragm structure and function...
March 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28624337/mobilization-of-prolonged-mechanical-ventilation-patients-an-integrative-review
#17
REVIEW
Heather Dunn, Laurie Quinn, Susan J Corbridge, Kamal Eldeirawi, Mary Kapella, Eileen G Collins
Mobilization of mechanical ventilation patients has broadened to include patients requiring prolonged mechanical ventilation (PMV). A previous systematic review outlined methodological flaws in the literature. The purpose of this integrative review is to evaluate existing publications to determine if mobilization interventions in PMV patients improve physical function, weaning rates, pulmonary mechanics, and hospital outcomes. An electronicsearch covering 2005-2016, included five bibliographic databases: CINHAL, PubMed, PEDro, EMBASE, and Web of Science...
July 2017: Heart & Lung: the Journal of Critical Care
https://www.readbyqxmd.com/read/28623885/monitoring-the-electric-activity-of-the-diaphragm-during-noninvasive-positive-pressure-ventilation-a-case-report
#18
Fabia Diniz-Silva, Anna Miethke-Morais, Adriano M Alencar, Henrique T Moriya, Pedro Caruso, Eduardo L V Costa, Juliana C Ferreira
BACKGROUND: In patients with post-extubation respiratory distress, delayed reintubation may worsen clinical outcomes. Objective measures of extubation failure at the bedside are lacking, therefore clinical parameters are currently used to guide the need of reintubation. Electrical activity of the diaphragm (EAdi) provides clinicians with valuable, objective information about respiratory drive and could be used to monitor respiratory effort. CASE PRESENTATION: We describe the case of a patient with Chronic Obstructive Pulmonary Disease (COPD), from whom we recorded EAdi during four different ventilatory conditions: 1) invasive mechanical ventilation, 2) spontaneous breathing trial (SBT), 3) unassisted spontaneous breathing, and 4) Noninvasive Positive Pressure Ventilation (NPPV)...
June 17, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/28620595/the-predicting-ability-of-serum-phosphorus-to-assess-the-duration-of-mechanical-ventilation-in-critically-ill-patients
#19
Reihanak Talakoub, Mahshid Bahrami, Azim Honarmand, Saeed Abbasi, Hamideh Gerami
BACKGROUND: No previous study exists to evaluate serum phosphorus (Ph) level as a predictor of the need to mechanical ventilation (MV). This study was designed to determine the predictive ability of admission serum Ph level on MV in patients admitted in Intensive Care Unit (ICU). MATERIALS AND METHODS: This prospective study was conducted on 100 patients (>16 years old), admitted to our ICU over 1-year. Patients were classified into two groups according to the days of the need to MV...
2017: Advanced Biomedical Research
https://www.readbyqxmd.com/read/28615115/circulatory-collapse-in-a-parturient-undergoing-cesarean-delivery-a-diagnostic-dilemma
#20
M M Tawfik, M E Taman, A I Tarbay, M Sayed, K A Awad
Embolic events including thromboembolism, air embolism, and amniotic fluid embolism can cause cardiovascular collapse during cesarean delivery. Differentiation between the three conditions is challenging because they share many of the initial clinical and echocardiographic findings, but an accurate, definitive diagnosis allows the administration of specific therapy that may help in saving the life of the mother and/or the fetus. We report a case of cardiovascular collapse during cesarean delivery under general anesthesia; massive pulmonary thromboembolism was suspected and unfractionated heparin was administered...
May 10, 2017: International Journal of Obstetric Anesthesia
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